NRNP 6566 Week 5 Knowledge Check
QUESTION 1
1. A 54-year women is 3 days post abdominal surgery for removal of a cancerous mass in her abdomen. She develops acute shortness of breath associated with tachycardia and hypotension. CT Scan of the chest is positive for multiple small pulmonary embol...
nrnp 6566 week 5 knowledge check question 1 1 a 54 year women is 3 days post abdominal surgery for removal of a cancerous mass in her abdomen she develops acute shortness of breath associated with
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NRNP 6566 Week 5 Knowledge Check
QUESTION 1
1. A 54-year women is 3 days post abdominal surgery for removal of a cancerous mass
in her abdomen. She develops acute shortness of breath associated with tachycardia
and hypotension. CT Scan of the chest is positive for multiple small pulmonary
embolism. What medication and dosing would you order initially to treat the
pulmonary embolism?
This patient should be given fondaparinuc (Arixtra) subcutaneously. Dosing is weight-
based:
1. 5 mg SQ once daily (for weight less than 50 kg
2. 7.5 mg SQ once daily (for weight ranges from 50-100 kg)
3. 10 mg SQ once daily (for weight exceeding 100 kg).
QUESTION 2
1. A 64-year man is recovering from a transurethral resection of the prostate for
treatment of benign prostate hyperplasia. The patient is receiving intravenous
antibiotics for the urinary tract infection. The post-operative course has been smooth
and the APRN is removing the 3-way Foley catheter when there is a sudden release of
bright red blood with many blood clots in the Foley bag. The patient becomes
hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms
and legs. The patient was immediately transferred to the surgical intensive care unit
(SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral
blood smear, partial thromboplastin time, Prothrombin time/international
normalization ratio (INR), and fibrinogen labs were drawn. Results were:
CBC with markedly decreased platelet count, peripheral blood smear showed
decreased number of platelets and presence of large platelets and fragmented red
cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin
time. The d-dimer was markedly elevated, and fibrinogen level was low.
Based on the clinical presentation and laboratory data provided, what is your working
diagnosis?
The working diagnosis for this patient is disseminated intravascular coagulation
(DIC). It is an acquired coagulation disorder that is most commonly caused by infections
(gram negative sepsis), malignant neoplasm, obstetric complication, liver disease, trauma,
and burns. This patient is positive for urinary tract infection. Thrombocytopenia (decreased
platelets), prolonged PT and aPTT, low fibrinogen levels, positive D-dimer, and schistocytes
are all indicative of an acute uncompensated DIC (active hemorrhagic event).
QUESTION 3
1. A 26-year-old male was injured in a motorcycle crash 3 days ago. He sustained an
acute subdural hematoma, acetabular fracture, and L2 fracture with spinal cord injury
and resulting paralysis. He has a warm swollen right lower leg. Duplex ultrasound of
the right lower leg is positive. What is the best treatment for this patient?
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, The duplex ultrasound of the right lower leg is positive indicating DVT. Patient is also
at higher risk for pulmonary embolism with the paralysis and the acetabular fracture.
Anticoagulation would have been indicated for this patient, but the subdural hematoma
would be a contraindication for anticoagulation. According to the ACCP guidelines, patients
with acute proximal DVT of the leg and contraindication to anticoagulation, the use of an IVC
filter is recommended.
QUESTION 4
1. A 44-year-old male is admitted to the orthopedic unit following a motor vehicle crash.
He has a femur fracture of the right leg. He is not actively bleeding and healthy. He
weighs 185 pounds. What should the APRN order as DVT prophylaxis?
This patient is at an increased risk of thrombosis and has no active bleeding or low risk for
bleeding, so the ACCP recommends anticoagulant thromboprophylaxis with LMWH (low
molecular weight heparin), low dose unfractionated heparin (LDUH) BID, LDUH TID or
fondaparinux (Grade1B).
QUESTION 5
1. A 16-year-old male is brought to the Urgent Care by her mother who states that the
girl has had an abnormal number of bruises and “funny looking red splotches” on her
legs. Bruises were noted about 2 weeks ago and have increased in number since this
time. There is no history of trauma to explain the bruising. Past medical history not
remarkable and she takes no medications. The mother does state the girl is
recovering from a “bad case of mono” and was on bedrest at home for the past 3
weeks. The girl noticed that her gums were slightly bleeding when she brushed her
teeth that morning.
Lab work completed show a normal hemoglobin and hematocrit with normal white
blood cell (WBC) count and differential. Platelet count of 50,000/mm3 was the only
abnormal finding. The staff also noticed that the venipuncture site oozed for a few
minutes after pressure was released. Immune thrombocytopenia purpura (ITP) is
suspected. What additional diagnostics should be ordered? If this diagnosis is
confirmed, how would you treat it?
Thrombocytopenia is the hallmark of Immune or idiopathic thrombocytopenia
purpura (ITP) which was found in this patient’s lab work. There is no definitive test for ITP
and the diagnosis is typically by exclusion. Antinuclear antibody testing may be done to
assess for autoimmune process ( risk factor). Bone marrow biopsy can be done to rule out
myelodysplasia.
Treatment is not usually initiated unless platelet count is less than 20,000or patient is
symptomatic. Once confirmed, initial treatment includes prednisone, 1-2 mg/kg/day. A high
dose of intravenous gamma globulin (1 gm/kg for 1-2 days) is also effective. When
prednisone therapy fails, splenectomy may be indicated.
QUESTION 6
1. A 44-year-old female with a mechanical mitral heart valve is scheduled for elective
abdominal surgery next week. The patient currently takes warfarin 5 mg daily for
prevention of thrombus. The patient is high risk for blood clot formation and needs to
This study source was downloaded by 100000851646087 from CourseHero.com on 12-13-2022 08:45:32 GMT -06:00
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